First Things First: Address the Itch
Why patient comfort should be at the top of the priority list when veterinarians see a dog with itchy skin for the first time.
Finding the underlying source of a pet’s allergies may take time, involving diagnostic testing and elimination of potential causes. But for veterinarians, it’s critical to approach each first-time visit of an itchy dog with a sense of urgency, said Andy Hillier, BVSc, Dipl. ACVD, Zoetis. “Make sure you take care of the presenting problem – get that dog comfortable,” he said. “Give the owner peace of mind knowing that they, and their pet, can sleep tonight.”
Itchy skin may not be an emergency. Yet Dr. Hillier contends that it is urgent – for the pet and the pet owner. “If you regard it as urgent, what that means is that you’re going to do something that you are confident is going to be effective in providing fast relief for that dog, something that starts working within a few hours, and certainly within 24 hours.”
Itchy dogs typically make up about a quarter of cases veterinarians will see. But there is more at stake than just treatment. An unsuccessful first visit can damage the veterinary-client-patient relationship. In those cases, clients don’t feel heard or valued. And if veterinarians recommend a quick fix that doesn’t do the trick, pet owners will be more hesitant to come in again, much less agree to a diagnostic work up. “What we try and emphasize to veterinarians is that even with the first-time case where the dog isn’t a train wreck, you should still use the best thing you’ve got available to take care of the problem,” Dr. Hillier said. “Taking care of the problem and meeting the owner’s expectations builds trust and confidence.”
Zoetis estimates that approximately 3.7 million pet owners recognize their dog has excessive itching and have spoken to a veterinarian at least once about the itching, but they are treating with OTC products at home. “While that may work for some patients, we believe that amongst those there is an opportunity for them to be treated more satisfactorily by a veterinarian with a prescription drug. Here are several million dogs where the owners have reverted to over-the-counter treatments because the issue wasn’t taken care of appropriately at the time of a veterinary consultation,” Dr. Hillier said.
An over-the-counter pet store remedy is often the path of least resistance. It’s easy for the pet owner to try a few shampoos or lotions and see what works. While some over-the-counter treatments may do an adequate job, Dr. Hillier said most pet owners end up dissatisfied and hop from one over-the-counter product to another. “What happens when we don’t take care of the itch on the first visit? Owners will listen to social media, the pet-sitter, the groomer and anybody else to find occasional solutions, but for the most part, they are left with a dog that continues to have a problem that leaves them dissatisfied and frustrated.”
Standard of care
Distributor reps can size up a veterinary clinic’s allergy and dermatology needs by asking the right questions. Before even getting into product categories, Dr. Hillier recommends distributor reps start by asking the veterinary team about their standard of care for the first-time itchy dog. According to market share research, for over 50% of those patients, veterinarians are prescribing steroids. Both topical and systemic steroids are used to control severe inflammation and itching.
The use of steroids comes with the increased risk of side effects and adverse events, even short-term use. For instance, in a study of dogs using regular doses of steroids for five to 14 days, one-third of owners reported their pet had urine accidents around the house. “So, steroids will likely result in improvement in itch, but may impose other challenges that are even more bothersome than the itch! Nobody likes finding and having to clean up urine accidents!” said Dr. Hillier. And that is not all. Dogs on steroids often eat and drink more, and may demonstrate behavior changes, all of which at the burden of care that is the opposite of the objective of the treatment.
Antihistamines are another approach veterinarians have used in the past to manage allergic dermatitis and itching. Dr. Hillier is very blunt about trying to treat dermatology issues this way. “Antihistamines are proven in multiple studies to have very limited or no beneficial effects, so we set ourselves up for failure and disappointment from an owner’s point of view by dispensing antihistamines or recommending over-the-counter antihistamines,” he said.
Fortunately, the introduction of products such as Apoquel (an oral tablet to treat allergic itch) and Cytopoint (a monoclonal antibody injection administered at the clinic) have given general practitioners some alternatives to steroids that are effective, safe, and applicable from the first visit on, Dr. Hillier said. “It’s a huge change for general practitioners.” The recently approved Apoquel Chewable tablet makes it even easier for owners to treat their dog with a treat-like chewable tablet that most pets take free choice.
Once the patient is comfortable, the veterinary team can begin the investigative work to determine the environmental factors or underlying inciting causes of the pet’s itching. Keep it simple, Dr. Hillier said. Veterinarians should rule out the obvious first like fleas and skin infections. It should be noted that not seeing fleas on a dog does not rule out fleas as a possible cause of the itching; it only takes one or two flea bites to cause the problem. Every itchy dog should be treated with an effective parasiticide.
For conditions that go beyond the first-time visit, veterinary clinics have several product categories to choose from once they determine what factors are contributing to the itching. These include:
- Medicated shampoos and rinses: These can contain antifungal, antibacterial, or antiparasitic ingredients to treat various skin infections.
- Topical ointments and creams: Used for localized skin issues like hot spots, allergies, or infections.
- Oral medications: Antibiotics, antifungals, and anti-inflammatory drugs to treat underlying causes of skin issues.
- Supplements: Omega-3 fatty acids and other supplements that promote skin health.
- Antibiotic sprays and wipes: For easy application on infected or irritated areas.
- Antifungal solutions: For treating yeast infections and ringworm.
- Dietary products: Special hypoallergenic or dermatological diets to manage food allergies and improve skin condition.
If the condition is recurrent and a more in-depth workup is necessary (like diet trials for food allergy), this is where the success of taking care of the itch quickly and effectively the first time – thus generating trust with the pet owner – really pays off. “Now they’ve got some confidence in the veterinarian,” Dr. Hillier said. “When you recommend a diagnostic work, because you’ve created a partnership and some trust, the pet owner will be more likely to say ‘yes’ to the suggested testing.”
The Value of Video Evidence
When an itchy dog comes into the veterinary practice, unless it’s severely affected, the veterinarian is usually not going to see the pet demonstrating that behavior in the consulting room. That tends to underplay the reality of what’s happening at home. Dr. Hillier recommends practitioners ask pet owners to take a short video on their smartphone of the dog’s itchy behavior at home before they come in for the appointment. “It’s one thing just to hear an owner saying their dog is itching, or scratching at its side, or rubbing its face on the ground, or chewing on its leg,” he said. “But if there’s a video that shows the dog just doesn’t stop, you know and understand the real concerns of the owner better, and the true urgency to prescribe effective treatment.”
Photo credit: istockphoto.com/Martinns; istockphoto.com/Thapana Onphalai/kobkik, istockphoto.com/O_Lypa
